Surrogate Medical Clearance: A Step-by-Step Guide to the Screening Process

Medical clearance is the reproductive endocrinologist's decision that your body and health history are compatible with a safe embryo transfer. The decision is made at the IVF clinic working with the intended parents. It usually comes after agency screening and a preliminary match, and before the transfer. It has five parts: a records review, an in-person medical evaluation, an infectious disease panel, a psychological evaluation, and the doctor's final decision. Start to finish, it commonly takes an estimated six to twelve weeks.

If you are reading this before you have contacted any agency, that is a sensible order. Most of what slows clearance down, and most of what complicates it, is visible in your own medical records long before a clinic asks for them.

Surrogate Compass is an independent platform that helps you understand eligibility, pay, the process and how programmes differ before you choose an agency. We do not screen, match or clear anyone. This page explains what the clinic does, so the step is familiar to you before you reach it.

Before You Start: What Medical Clearance Actually Decides

Clearance is a clinical judgement, not an agency form. It is issued by the intended parents' reproductive endocrinologist (RE). It means the RE has reviewed your uterus, your pregnancy history and your general health, and judged them compatible with a safe transfer.

Three things about it are easy to miss.

• It is specific to one clinic and one match. Clearance from one IVF clinic does not transfer to another. A different clinic applies its own protocol.
• It is separate from agency screening. You can pass an agency's application, interview and background check requirements and still not receive medical clearance. The agency decides whether to work with you. The RE decides whether a transfer is medically appropriate.
• It has two required parts. One is the physical and medical evaluation. The other is the psychological evaluation. The RE needs both.

Medical clearance also does not decide some things. It does not settle the legal side, which is handled through the surrogacy contract and your own independent attorney. It does not guarantee that a transfer will work or that a pregnancy will follow. For where clearance fits within the full surrogate screening process, including the steps before it, see that guide.

Step 1: Medical Records Review

The clinic starts with paper. Before anyone examines you, the RE or a nurse reviews your records. The agency coordinator usually collects these with your signed release forms.

Records commonly requested include:

• OB/GYN records for each prior pregnancy and delivery, including prenatal care, complications and how each birth went.
• Cesarean records, including the operative notes. These notes describe the incision type and any problems during surgery. A summary or discharge letter is often not enough.
• Records of prior uterine surgery, such as a myomectomy (fibroid removal) or a D&C.
• General medical history: chronic conditions, current and past medications, and your BMI history.

The review comes before the clinic schedules an in-person visit. A records review alone can lead the RE to decide not to proceed. That is not a judgement about you as a person. It is a judgement about whether this clinic's protocol fits your history.

BMI and age limits are not national rules. Each RE sets parameters for their own clinic, and those parameters differ. A number you have seen on one agency's website may not be the number this clinic uses.

Records retrieval is one of the most common causes of delay at this stage. Some offices respond within days. Others take weeks, or have archived older files, or have closed.

Step 2: The In-Person Medical Evaluation

The visit happens at the intended parents' IVF clinic. That clinic may be in another city or another state, so travel is often involved. Travel costs are usually addressed in the surrogacy agreement, but this is a contract term, not a universal rule. Ask who pays for travel, how it is paid (booked for you or reimbursed), and when.

A typical evaluation includes the following. Clinics vary, and your clinic's protocol decides what is actually done.

• Physical exam. A general health check, vital signs, and height and weight.
• Bloodwork. This includes the infectious disease panel described in Step 3, and often other routine labs.
• Uterine evaluation. Usually a saline infusion sonohysterogram (SIS), sometimes a hysteroscopy. In an SIS, saline is passed through a thin catheter into the uterus while the cavity is viewed by ultrasound. A hysteroscopy uses a small camera passed through the cervix. Both look for fibroids, polyps, scar tissue (adhesions) or structural differences. Many women describe cramping during and after an SIS. Ask the clinic what to expect and whether pain relief is offered.
• Transvaginal ultrasound. This assesses your uterine lining and your ovaries, including an antral follicle count (AFC). You will not be providing eggs, but the AFC adds to the clinic's overall picture of your reproductive health.
• Pap smear, if yours is not current under the clinic's protocol.
• Drug screening.

Plan for the visit to take several hours. Some clinics split it across two days, which may mean an overnight stay. Clinical standards for obstetric and gynecologic evaluation come from professional bodies such as the American College of Obstetricians and Gynecologists, and each clinic builds its own protocol on that kind of guidance. For a closer look at each test, see the guide to surrogate medical screening.

Step 3: Infectious Disease and FDA Compliance Testing

This panel is required regardless of how healthy you are. The reason is regulatory, not personal.

Federal rules in 21 CFR Part 1271 govern human cells and tissues, including reproductive tissue used in embryo transfer. The U.S. Food and Drug Administration administers these rules. Clinics apply the regulation alongside professional guidance from the American Society for Reproductive Medicine, which recommends infectious disease screening for gestational carriers. Together, these are why IVF clinics run a standard panel on every gestational carrier, not only on candidates with a particular history.

The panel commonly includes:

• HIV 1 and 2
• Hepatitis B surface antigen
• Hepatitis C antibody
• HTLV I and II
• Syphilis (RPR or VDRL)
• CMV (cytomegalovirus)
• Gonorrhea and chlamydia

Some clinics add other tests.

A reactive result does not automatically disqualify you. Some results are common. CMV, for example, is a widespread virus, and many adults test positive for past exposure. Other results need confirmatory testing before anyone makes a determination. The RE reviews the results, not the agency.

If you have a partner or spouse, they are typically asked to complete the same panel.

Results also expire. Testing has to fall within a set window before the embryo transfer. If the transfer is delayed significantly, some or all of the panel may need to be repeated.

Step 4: Psychological Evaluation and Counseling

This part is required for clearance, not optional. ASRM guidance recommends psychological evaluation for all gestational carriers.

The evaluation is done by a licensed mental health professional (LMHP) with experience in third-party reproduction. That is usually a psychologist or a licensed clinical social worker. It typically has two parts:

• A clinical interview. This is a conversation about your life, your reasons and your support.
• A standardized assessment. This is often a written questionnaire such as the MMPI-2 or the PAI. These are common examples. Clinics and evaluators use different instruments.

Topics usually covered include your reasons for considering surrogacy, your understanding of relinquishment (handing the baby to the intended parents at birth), who supports you at home and in your wider life, any history of mental health treatment, and how you would keep healthy boundaries with the intended parents.

A partner or spouse typically joins at least part of the evaluation.

The LMHP writes a report for the RE and the agency. It may recommend clearance, clearance with conditions, or further evaluation. This is not a pass or fail test. The report documents your readiness, and conditions such as a recommendation for added support are common.

This evaluation is also different from ongoing counseling. Many agencies offer or require counseling throughout the pregnancy and after delivery. That is a separate, continuing relationship. The surrogate psychological screening guide covers the evaluation in more detail.

Step 5: The RE's Clearance Decision

Once every result is in, the RE reviews the whole file: the records, the physical exam, the infectious disease panel, the uterine evaluation and the psychological report. The decision is then communicated to the agency and to you, usually in writing.

Clearance can be:

• Unconditional. The file supports moving toward transfer.
• Conditional. Something needs to happen first. For example, a polyp may need to be removed before the transfer goes ahead.

If clearance is not granted, the RE typically explains the clinical reason. Depending on what it is, you may be able to work with a different clinic, or reapply after a specific condition is addressed. Because the decision is tied to one clinic and one match, a "no" from one RE is not a permanent disqualification everywhere.

Clearance is also not the finish line. The legal process, meaning the surrogacy contract negotiated with your own independent attorney, typically begins after clearance or runs alongside it. Both medical and legal clearance are needed before a transfer can be scheduled. Surrogacy law differs a great deal from state to state, which is one reason the legal step matters. If the clinic is in another state from you, that is part of what the attorneys work through.

Clearance does not mean a transfer will succeed or that a pregnancy will follow. It means the RE has judged it medically appropriate to try.

Typical Timeline: What Medical Clearance Takes

These are estimates, described from what agencies and clinics commonly report. Your own timeline may be shorter or longer.

Some of these overlap, which is why the total is shorter than the stages added together. The psychological evaluation, for example, can happen while lab results are pending.

What most often stretches the timeline:

• Slow records offices, especially for older births or practices that have closed.
• Clinic availability, and travel that needs to fit around your work and childcare.
• Findings that need follow-up, such as confirmatory testing or a minor procedure.
• A partner's tests or interview that have not yet been scheduled.

For how this stage fits into the full sequence, from application through delivery, see the overview of the surrogacy process for surrogates.

When the Process Gets More Complicated

Not every file is simple, and that is normal. These are the situations that most often add steps or time. In each case, the threshold is set by the RE at that clinic, not by a national rule.

Prior cesarean sections. The operative notes are read carefully. The RE looks at how many cesareans you have had, the incision type and any recorded complications. Multiple cesareans may lead to additional uterine evaluation. There is no single nationwide limit.

Findings on the SIS or hysteroscopy. Polyps or fibroids may need a minor procedure before clearance. The RE specifies what is needed and when the file can be reviewed again.

Reactive infectious disease results. Confirmatory testing adds time. Some results lead to a consultation with another physician before a decision.

BMI outside the clinic's range. The RE sets the range. This is a clinical judgement about safety, not an agency rule, and ranges vary between clinics.

Mental health history. Past treatment is not automatically disqualifying. The LMHP looks at your current stability and support. Being open during the evaluation matters, because an evaluator who learns of history later than expected has to reassess.

A partner's evaluation is delayed. If your partner's tests or interview are required and not done, the whole clearance waits.

Clinic-specific extra testing. Some clinics go beyond ASRM guidance and ask for added tests, such as a thrombophilia panel or thyroid testing. Your agency coordinator can confirm what a particular clinic requires.

What You Can Do to Prepare

Most of the preparation is administrative, and you can start it now.

• Request your own records early. Ask each OB/GYN office and hospital where you delivered for prenatal records, delivery records and, for any cesarean, the operative report. Keep copies.
• List your providers. Names, addresses and approximate dates for each pregnancy, surgery and ongoing condition make release forms faster.
• Note your medications and history. A simple written list helps at the records review and the exam.
• Talk with your partner, if you have one. Their testing and interview are part of the timeline.
• Write down your questions about cost. Who pays for screening, travel and any time off, and how each is paid, are contract questions. Your agency and your attorney can confirm the answers for your own programme.